Friday, 19 January, 2018

Trump administration will allow states to test Medicaid work requirements

Seema Verma administrator of the Centers for Medicare and Medicaid Services led efforts to require work for Medicaid recipients while in charge of Indiana's program. She was sworn in as administrator of the Centers for Medicare and Medicaid Services Trump administration allow work requirements in Medicaid
Rita Gibson | 14 January, 2018, 03:17

Republicans have long wanted to add work requirements for Medicaid recipients - which covers almost 75 million low-income children, adults and elderly and disabled Americans.

It's still unclear when and if Pennsylvania will apply for the federal waiver. "It would only apply to the ten or so states run by far-right Republicans who have asked to do this".

The Obama administration turned down several state requests to add a work requirement.

Those who don't comply would be suspended from receiving health care benefits until they meet their required hours for a month.

Verma and other conservatives argue that forcing working-age Medicaid beneficiaries to work or seek work will improve their health.

In Massachusetts, employers are facing a shortage of workers in a low unemployment economy and state officials are struggling to cover the cost of growing Medicaid enrollment in the face of threatened cuts in federal health care spending.

"All of this on paper may sound reasonable, but if you think about the people who are affected, you can see people will fall through the cracks", said Judy Solomon of the Center on Budget and Policy Priorities, which advocates for the poor. He said the changes will force many to lose health coverage.

Joan Alker, the executive director of Georgetown University's Center for Children and Families, tells Mother Jones that it's clear from the way the announcement was crafted that CMS is preparing for a legal challenge.

Medicaid is the nation's largest public insurance program, providing health benefits to almost 74 million Americans, chiefly low-income adults.

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The work requirement is aimed at "able-bodied" adults, and excludes those on Medicaid for disability, the elderly, children and pregnant women. About 60 percent of the Medicaid recipients whom the federal government considers to be able-bodied adults are already working, according to the Kaiser Family Foundation. Almost 8 in 10 are part of families where at least one person works, and 60 percent are working themselves. But a closer look reveals that many of those people face obstacles to entering the workforce.

Walthall said the guidance from CMS supports Indiana's plan to connect Medicaid recipients "to more meaningful community engagement". A comprehensive study of 11 mandatory work programs found that only two decreased poverty.

The proposed Arizona policy change originated with a state law passed in 2015 by legislators who say work requirements incentivize people to gain financial independence from government support and are also critical to maintain Medicaid's viability.

Many Medicaid recipients are already employed.

Public Citizen agreed, calling the idea of work requirements "cruel, stupid and illegal".

A University of MI team recently published data in JAMA Internal Medicine from detailed survey of more than 4,000 MI residents enrolled in the state's expanded Medicaid program. The requirements would mandate that people in the affected states must be working, enrolled in school or job training, volunteering, or providing care for a family member - activities referred to as "community engagement" - in order to remain eligible for Medicaid.

Verma, who worked with Kentucky and IN on their work requirement waivers as a health consultant before joining the Trump administration, recused herself from the decision on those states waiver requests.

And as Kaiser's Drew Altman wrote in April, it's unlikely that the change will affect that many Medicaid beneficiaries, because such requirements usually have key exemptions for family care, the disabled and those of retirement age.

Just over one-fifth of Medicaid enrollees who hold part-time jobs cited economic factors, such as the inability to find full-time positions and weak business conditions, as the reason they aren't working more.

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